Inspection on 12/04/07 for Merevale House

This inspection was carried out on 12th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Merevale House Old Watling Street Atherstone Warwickshire CV9 2PA Lead Inspector Patricia Flanaghan Unannounced Inspection 12 and 23 April 2007 09:30 X10029.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Merevale House DS0000068146.V335978.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People and Care Homes for Adults 18 – 65*. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Merevale House DS0000068146.V335978.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Merevale House Address Old Watling Street Atherstone Warwickshire CV9 2PA 01827 717866 01827 717866 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Merevale House Residential Home Ltd Mrs Anne Fretwell Care Home 31 Category(ies) of Dementia (16), Dementia - over 65 years of age registration, with number (15) of places Merevale House DS0000068146.V335978.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Date of last inspection 16 February 2006 Brief Description of the Service: Merevale House is registered to provide a home for both younger adults and elderly people with dementia. The original part of the house provides accommodation for people over the age of 65 whilst the extension known as The Lodge provides accommodation for those who are under 65. Design and Layout of home: Merevale House is a converted detached Victorian house with enclosed patio and garden area to the front and landscaped gardens to the rear, which adjoin the towpath of the Coventry/Lichfield Canal. The part of the house known as The Lodge has been built onto the back of this house. There are four ‘young’ people with early onset dementia in Fifth Lock Cottage, which is adjacent. However, since the purpose of the home is to meet the very individual needs of each service user, there is of necessity some fluidity about these arrangements The main house has two lounges. One is L shaped, and has been arranged to provide sitting and dining areas. There are three bathrooms that are equipped and adapted for service users with mobility difficulties. There are thirteen single bedrooms and one double bedroom and all have en-suite facilities, or, in some cases, share one en-suite toilet between two bedrooms. There is a Stannah chairlift for access to the first floor accommodation. The Lodge is a purpose built accommodation, situated at the back of the main house. This has twelve single bedrooms, all with en-suite facilities. There are two bathrooms, one upstairs and one downstairs, which both have Parker baths. The upstairs bathroom is large enough to enable someone using a wheelchair to use the bathroom comfortably. There is a separate WC downstairs. There are sluice rooms on each floor. There are two lounge/dining rooms, one large and one small. There is a small kitchenette, which is used for drink and snack making. There is a shaft lift. Doors are discretely alarmed, to let staff know when someone is leaving. Outside there is a carefully laid out ‘walking path’ through the gardens. Fifth Lock Cottage, which is in the grounds of Merevale House, provides four single rooms, each with ensuite facilities. Communal space also includes a small kitchen, lounge and bathroom. The current scale of charges range from £420 - £900 per week, dependent on needs. Additional charges are made for hairdressing and some holidays, trips and days out. Merevale House DS0000068146.V335978.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for residents and their views of the service provided. This process considers the care home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This unannounced inspection visit took place on Monday 23rd April 2007 between 9.30am and 8.00pm. An initial visit had been made on Thursday 12th April, but the inspection had not proceeded because some staff and residents’ were ill. Before the inspection, a random selection of residents and relatives were sent questionnaires to seek their independent views about the home. Completed questionnaires were received from four visitors and eighteen residents and responses are included where appropriate in this report. The registered manager of the home completed and returned a questionnaire containing further information about the home as part of the inspection process. Some of the information contained within this document has also been used in assessing actions taken by the home to meet care standards. Three residents were ‘case tracked’. This involves establishing an individual’s experience of living in the care home by meeting or observing them, discussing their care with staff, looking at their care files, and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. Documentation maintained in the home was examined including staff files and training records, policies and procedures and records maintaining safe working practices. The registered manager and the care manager were present throughout the day, and the inspector was able to tour the home, and spend time speaking with residents, visitors and staff. The inspector was invited to share lunch with the residents in the main residential unit and was able to observe care practices and staff interaction with the people who live in the home during meal times. The inspector had the opportunity to meet most of the people who use this service and talked to six of them about their experience of the home. People were able to express their opinion of the service they received. General conversation was held with other residents along with observation of working practices and staff interaction with residents. The inspector also spoke with two visitors about their experience of the home. Merevale House DS0000068146.V335978.R01.S.doc Version 5.2 Page 6 The inspector would like to thank the people who live in the home and staff for their cooperation and hospitality. What the service does well: Merevale House provides a relaxing, comfortable, supportive and stimulating environment. On the day of the inspection all of the residents appeared to be relaxed, the staff were observed to support the residents in a sensitive and discreet way that promoted dignity and independence. The residents continue to be able to participate in a broad range of activities that reflect their personal preferences, promote their independence and that they enjoy. All of the residents were engaged in valued and fulfilling activities throughout the inspection, activities included reading newspapers, playing pool, singing and dancing, looking at ‘life history’ books, chatting with staff and each other, having a hand massage and knitting. The residents are also able to take part in day trips and holidays if they wish. All of the documents seen were well ordered, easily accessible and up to date. Recorded information about service users is detailed, person-centered and provides staff with clear guidance on residents’ needs, goals and wishes. The manager said the home focuses on providing person-centred care and that choice and empowering the individual are paramount at Merevale House. Residents health needs are monitored and well met with the support of the staff. Staff receive a high level of training and support to ensure residents’ needs are met safely and consistently. The environment is decorated and furnished to a good standard creating a homely atmosphere. The home is well managed and has a consistent, experienced staff team. To ensure the home is run in the best interests of residents, systems are in place that seek the views of service users, staff, relatives and outside stakeholders on the quality of the service. The completed questionnaires returned by residents and relatives to the Commission included comments such as, • • Highly recommended. Excellent care of my (relative) I am very pleased with the care my (relative) is given. The staff are excellent. I feel they care about the relatives as well as the people living there. My (relative) is well looked after and is very contented. We are happy with the way the home is run and the care is excellent. DS0000068146.V335978.R01.S.doc Version 5.2 Page 7 • Merevale House • • • I have been extremely happy with the care, it is excellent “I came to visit Merevale to see what care I would receive. I was happy to move into the home.” “Merevale House is a wonderful care home.” There are excellent systems in place to ensure that residents and staff safety, health and welfare are fully protected. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Merevale House DS0000068146.V335978.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Merevale House DS0000068146.V335978.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Standard 6 is not applicable. Quality in this outcome area is good. All residents are assessed prior to moving into Merevale House and given assurances that their needs can be met by the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care files belonging to three people who use the service were examined as part of the case tracking process. These confirmed that a full assessment of need is undertaken by the home ensuring that the person’s needs will be met by staff at Merevale House. This includes an assessment of the persons physical and mental health needs, social skills and support required to Merevale House DS0000068146.V335978.R01.S.doc Version 5.2 Page 10 participate in activities of daily living. The assessments contained in care files accessed by care staff included a social care assessment to give staff information about the resident, including their preferred interests and hobbies, giving the staff a better insight to the person. There is evidence that this assessment is completed with the person and includes their own perception of their needs. Care plans were devised from the assessments to enable staff to have the information required to meet the needs of the people who use this service. The home’s Statement of Purpose is regularly reviewed. The document is made available to prospective residents so they have all the information they need to make an informed choice about the home. Comments received from people who use this service in the questionnaires returned to the commission include: “I came to visit Merevale to see what care I would receive. I was happy to move into the home.” “My family received information before deciding this was the right place for me.” “I was happy with all the information given to me.” “Before any decisions were made, we received enough information to know it was the right place.” Merevale House DS0000068146.V335978.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service Users, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. The home has a comprehensive care planning system in place which provides the staff team with the information required to enable them to support the people who use this service to meet their identified needs in a manner which reflects their personal preferences. Systems in place ensure that the people are consulted, and participate in all aspects of life within the home. This judgement has been made using available evidence including a visit to this service. Merevale House DS0000068146.V335978.R01.S.doc Version 5.2 Page 12 EVIDENCE: A sample of care files of people who live in this home were examined. These were well ordered and contain clear and concise information that details the residents needs and how these are met. People are fully involved in the information in their care plan. Information includes, personal details, a pen picture, daily care plan, needs assessments, guidance, appointments, risk assessments, action sheets and manual handling assessments. The emphasis of the plans seen was to maintain and promote the residents’ independence and offer the residents real choice as to how and when their needs are to be met. Observations during the inspection confirmed that the care plans are implemented. Discussions with a number of staff confirmed that they have a sound understanding of each individual residents needs and how the people prefer these to be met. The home maintains daily records detailing the support that was provided and the outcome for the resident. Care staff complete daily records, but some entries could lack the detail required to ensure that all staff are aware of daily changes and events. The registered manager explained that daily recordings are being completed on new forms that had recently been introduced and were being ‘trialled.’ She undertook to ensure that care staff have sufficient space on the form to detail any follow up action required or taken as appropriate. Risk assessments have been completed and strategies in place to reduce the risks identified. Both care plans and risk assessments are reviewed regularly at planned intervals or as the residents needs change. A record is maintained of all contact with health care professionals, including the outcome for the residents. Arrangements are made for the people living in the home to have Well Woman or Well Man checks annually ensuring healthcare professionals monitor their health. Observations during the inspection, discussions with staff and people who use the service and examination of records confirmed that the residents continue to be enabled to make decisions that affect their every day lives. It was clear through talking with people who use the service, the evidence gathered and observations made, that the manager and staff are committed to providing care that is person-centered. Staff receive a good level of training that helps them to understand and meet residents’ needs. Merevale House DS0000068146.V335978.R01.S.doc Version 5.2 Page 13 Systems to ensure the safe administration, storage and receipt of medications are satisfactory. The operations manager closely monitors staff in administration procedures to ensure accuracy. The storage and administration of controlled drugs was checked and found to be accurate. All records are maintained in a register and regularly audited. Time was spent observing staff with residents in communal areas. People were being cared for in a respectful manner, ensuring dignity and self esteem and interaction was comfortable and friendly. People spoken with confirmed that this was always the case. They could spend time in their own room according to their personal wishes. It was also noted that people received personal care behind closed doors. Comments by people in discussion and in the completed questionnaires included: “I think the care is very good and I want to make this known.” “The staff are always around if I need anything.” “Merevale House is a wonderful care home.” Comments received from visitors in the questionnaires returned to the commission include: “Highly recommended. Excellent care of my (relative.)” I have been extremely happy with the care, it is excellent Merevale House DS0000068146.V335978.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service Users have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is excellent. The people living in this home have excellent support to live ordinary and meaningful lives and to participate in and contribute to the community in which they live. This judgement has been made using available evidence including a visit to this service. Merevale House DS0000068146.V335978.R01.S.doc Version 5.2 Page 15 EVIDENCE: People who live in this home have a ‘memory’ book that illustrates significant moments in their lives and reflects the person’s hobbies and interests, using photographs, clippings and other memorabilia. The home continues to add to these books so that they include important invents in the persons life since they have moved into the home. The books seen included photographs of the residents on holiday, enjoying activities and relaxing in the garden. The residents are supported to make choices and have control over their lives. For example, choices could be made about the times of going to bed and getting up, what meals were taken and where, whether they joined in activities, whether they chose to sit in the communal sitting areas or their own bedroom. A resident commented, “I do what I want, I like to stay in my room and listen to my music alone.” Residents are able to bring personal possessions with them into the home and this was evidenced when bedrooms were viewed. Annual holidays are planned and based on individual persons choice and capabilities resulting in different types of holidays being arranged. For example, some people went to Frankfurt for a Christmas market while others enjoyed holidays in England. People spoken with were able to confirm this approach to planning holidays and group activities. Relatives are also able to join their relative on holiday if they wish. Throughout the inspection the people who live in the home were either engaged in activity or spending time chatting with staff. All of the residents spent some or all of the time engaged in a meaningful activity, these included looking at their ‘life history’ books, reading newspapers, playing dominoes, singing and dancing, knitting, playing pool and hand massage. In addition to this the residents are supported to access the local community and take part in activities which promote their independence, such as bedroom cleaning and cooking and participating in individual hobbies. Hobbies pursued include going to a night club, playing golf, fishing, gardening, and DIY. The residents have formed their own five-a side football team and play in the local league. Football strips have been designed by the team and purchased by the home. Two residents spoken with clearly enjoyed speaking about recent matches they have played and said they were looking forward to playing a game on the evening of the inspection. Merevale House DS0000068146.V335978.R01.S.doc Version 5.2 Page 16 The home uses pictorial prompts to assist the residents to make choices about what they would like to eat. For some residents the ability to make a choice or communicate wishes is reliant upon the positive relationships that have been built between the staff and residents, the observation skills of the staff and use of a variety of communication methods, including gestures and non-verbal cues. This was observed throughout the inspection. A visitor said that she considered the staff as family rather than ‘workers’ and that the home is like “someone’s house rather than a care home.” The inspector joined the residents in the main home for a meal at lunchtime. There were several choices available and all were very well presented and served well by the care staff. Staff offered assistance to residents cutting up their food and discreetly helped to feed those residents who are unable to feed themselves. The meal was unhurried with a friendly atmosphere which residents clearly enjoyed. Three residents told the inspector that food is always good in the home and they look forward to meal times. The manager told the inspector that a person recently admitted to the home required their food to be specially prepared according to their religious beliefs. The manager made arrangements for this person to visit a specialist butcher to ensure the food provided was suitable. The cook also had training on the correct preparation and serving of the food. This was all documented in the person’s care plan. A visitor told the inspector that staff always ask if she would like to join her relative for a meal and commented that “the meals are always well presented, varied and look very appetising.” The kitchen was visited and was clean and in good order. Merevale House DS0000068146.V335978.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service Users feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is excellent. People who use this service are able to express their concerns, and have access to a robust, effective complaints procedure and are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Discussion with people who use the service and staff and examination of the complaints record for the home demonstrates that there continues to be an open and positive approach regarding the service at Merevale House. There are policies and procedures in place regarding safeguarding adults, but the most positive safeguard continues to be the ethos and atmosphere apparent in the home. People living in the home said they felt safe in their environment and with the people who were caring for them. People said that they are able to talk to the manager or any member of staff about things that concern them. Merevale House DS0000068146.V335978.R01.S.doc Version 5.2 Page 18 Visitors spoken with said that if they had a complaint they would speak with a member of staff or the manager. One visitor commented “I have never had a complaint, but I know if I did, it would be dealt with immediately.” Comments by people who live in the home, in discussion and in the completed questionnaires included: “I have nothing to complain about, only praise for all that is done” “I never had to think about it, if needed I would tell staff.” Training information provided by the manager indicates that staff attended training in adult protection during 2006 and that this training is ongoing in 2007 through Warwickshire’s Vulnerable Adult Protection Committee. When staff were asked they were able to demonstrate their awareness of adult protection. Neither the Commission nor the home have received any complaints since the last inspection. Merevale House DS0000068146.V335978.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24, 25 and 26 Quality in this outcome area is good. The people who live in this home have a homely, private, comfortable and safe environment, which meets their needs, individual lifestyle and level of independence. This judgement has been made using available evidence including a visit to this service. Merevale House DS0000068146.V335978.R01.S.doc Version 5.2 Page 20 EVIDENCE: A tour of the home confirmed that the residents continue to live in a comfortable, clean and homely environment. Communal space in the main house includes two lounges. The smaller lounge is used as a ‘quiet’ area. Residents were observed chatting with their visitors or reading newspapers. The second lounge is ‘L’ shaped and divided to include lounge and dining areas. There is an attractive, enclosed, garden at the front and rear of the property. This has three seating areas, a pond and wellmaintained borders. Bedrooms are located on the first and ground floor of the home. These are decorated and furnished to reflect the preferences and personalities of the residents to whom they belong. Each bedroom has a wash hand basin and en-suite toilet. Specially adapted bathrooms and toilets are available on each floor. In the Lodge there are twelve single bedrooms, eight of which are on the first floor. All have en suite facilities including a toilet and sink. In addition there is a shower room on the first floor and a large bathroom, with bath chair, and separate toilet on the ground floor. The Lodge also has a shaft lift. Communal areas include a large lounge/ diner, which is also used for activities and a smaller television lounge. A small kitchen enables the residents to make drinks and snacks. Fifth Lock Cottage, which is in the grounds of Merevale House, provides four single rooms, each with en suite facilities. Communal space also includes a small kitchen, lounge and bathroom. One of the people who live in this cottage was happy to show the inspector around the home and for their bedroom to be looked at. They said they had everything they needed in their bedroom, which was clean and reflected their lifestyle interests. Decor, furnishings and fittings were all clean and to a high standard and the home smelt fresh and clean. People who use the service are encouraged to see the home as their own and are able to move around easily and freely and to go to their bedroom if they wish. There are established policies and procedures in place for the control of the risk of infection in the home and staff practices during the visit were seen to be safe. Infection control training is included in mandatory training for all staff and is accessed through a distance-learning course. Laundry facilities are located in the grounds of the home and these meet the needs of the home. Merevale House DS0000068146.V335978.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. The people living in this home are supported by an effective and competent staff team who have the skills and knowledge to meet their individual and collective needs, which promotes their health and well being. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three staff files were examined and all contained the required information and documents including Protection of Vulnerable Adults and Criminal Records Bureau checks, and demonstrated that the home has robust recruitment practice to protect the residents from the employment of unsuitable people. Merevale House DS0000068146.V335978.R01.S.doc Version 5.2 Page 22 Observation of care practice and discussion with staff on duty at the time determined that positive relationships exist between people and the staff supporting them. Support was provided discreetly to residents and they appeared comfortable and relaxed with staff members. Staff training records confirmed that all new staff undertake the ‘Skills for Care’ induction upon commencing work. A discussion with a recently employed member of staff said that the induction also includes ‘shadowing’ an experienced staff member. More specialised training in dementia care, the individual needs of the resident, the role of the care worker and death and dying is also provided for staff. Evidence was also available to confirm that residents are offered the opportunity to undertake training with the staff if they wish in areas such as food hygiene and customer relations. Other training undertaken by care staff in the past year includes mandatory training such as First Aid, Moving and Handling, Health and Safety, Food Hygiene and Fire Training and Infection Control, Death and Dying, and medication awareness. Staff are also undertaking protection of vulnerable adults training. There is a rolling programme of assessment of care staff towards an NVQ (National Vocational Qualification) Level 2 or 3 in care and 70 of staff now hold this qualification. This ensures that staff have had the appropriate training to be able to carry out their role to meet the diverse needs of the people living in the home. Members of staff spoken with were positive about their training opportunities and knowledgeable on areas asked about. The staff stated that they enjoy working in the home. One staff member said “this is the best home I have ever worked in.” Merevale House DS0000068146.V335978.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is excellent. The people living in this home continue to benefit from a well-run home that has effective systems in place to ensure their health and well-being is promoted and maintained. This judgement has been made using available evidence including a visit to this service. Merevale House DS0000068146.V335978.R01.S.doc Version 5.2 Page 24 EVIDENCE: Discussion with people using the service, staff and the manager, examination of home records and observation of care practices demonstrated that the service is managed by a competent and skilled management team who fosters an atmosphere of openness and respect with people, and that staff feel valued and their opinions matter. There are affective quality assurance and monitoring processes in place to ensure the home is meeting the needs of the people living there. This includes internal audit against the National Minimum standards, an action plan is developed to address the issues raised. Quality monitoring covers all areas of the service and includes, training and development of staff, food provision, staffing levels and complaints. Quality assurance records looked at show that the service has a commitment to involving people using the service, relatives and friends, health-care professionals and staff through seeking their views by questionnaire or consultation meetings. The staff demonstrated commitment to fulfilling the homes philosophy of care, which is detailed fully in the Statement of Purpose. The ‘ friends of Merevale’ hold regular meetings, inviting residents, relatives and staff. The minutes made during these meetings are provided to the manager. Residents said that they regularly meet with the provider/manager of the service to discuss issues in the home. The home employs external support to complete dementia care mapping. Discussions with the residents and observations throughout this and the previous inspection indicated that the residents enjoy living in the home. The manager stated that no one employed by the home acts as appointee for the residents. This responsibility is either retained by the residents, their family or by an external advocacy agency. The home does accept responsibility for safe keeping of small amounts of money if the resident wishes. Examination of the records relating to this demonstrated that the homes procedures protect the residents. Health and safety management in this home is to a high standard and all records seen relating to this were up-to-date and in good order. Safe practices were observed in the home and records show that this is further promoted through training for staff in manual handling, food hygiene, first aid, fire safety and infection control. Merevale House DS0000068146.V335978.R01.S.doc Version 5.2 Page 25 Pre-inspection information received shows that maintenance of fire fighting equipment, electrical appliances and central heating systems takes place on a regular basis. Excellent systems are in place for ensuring that food hygiene is maintained and monitored, this includes recording fridge and freezer temperatures and cooked meats. Fire safety management includes regular testing of fire alarms and emergency lighting and all records relating to fire safety management were up-to-date and in good order. A record is maintained in the home of any accident or incident that happens to a service user. All records seen during this visit were stored securely and in good order. Merevale House DS0000068146.V335978.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 X 3 3 4 X 5 X 6 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 4 ENVIRONMENT Standard No Score 19 3 20 3 21 3 22 X 23 X 24 3 25 3 26 3 STAFFING Standard No Score 27 4 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No Score 31 4 32 X 33 4 34 X 35 3 36 X 37 X 38 3 Merevale House DS0000068146.V335978.R01.S.doc Version 5.2 Page 27 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Merevale House DS0000068146.V335978.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI. Merevale House DS0000068146.V335978.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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